Gender-Specific Drinking Contexts Are Associated With Social Harms Resulting From Drinking Among Australian Young Adults at 30 Years

Aims

Understanding contexts in which social harms from drinking occur can help develop context-based harm reduction efforts. However, there is little knowledge of specific drinking contexts where such harms occur and whether these are gender or age specific. We aimed to investigate associations of a range of drinking contexts and social harms from drinking among young adults at age 30.

Methods

We used data from 2187 30-year-old adults. Latent constructs of gender-specific drinking contexts were created using factor analysis. We performed multivariate logistic regression between drinking contexts and a range of social harms from drinking, separately by gender.

Results

After accounting for social roles and binge drinking, gender-specific solitary drinking contexts (‘home drinking’ for men and ‘daytime drinking’ for women) were positively associated with marital problems and problems with other family members and friends. Conversely, ‘social drinking’ was not. Work-related drinking among men was associated with marital/intimate relationship problems and friendship problems. After accounting for mental health symptoms, women’s home drinking was associated with marital problems.

Conclusion

We found that experiences of social harms from drinking at 30 years differ depending on the drinker’s gender and context. Our findings suggest that risky contexts and associated harms are still significant among 30-year-old adults, indicating that a range of gender-specific drinking contexts should be represented in harm reduction campaigns. The current findings also highlight the need to consider gender to inform context-based harm reduction measures and to widen the age target for these beyond emerging adults.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers' reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers' self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

Social Drinking Contexts and Their Influence on Problematic Drinking at Age 30

Aims: Understanding the social contexts in which problematic drinking occurs can inform prevention strategies. In this article, we investigate gender-specific social contexts associated with problematic drinking and depression among adults aged 30 years. Because depression has been consistently linked with harmful alcohol consumption, we will also examine its association with drinking contexts. Methods: We used data from 2490 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exploratory and confirmatory factor analyses were used to identify latent constructs of drinking contexts stratified by gender, with subsequent regression analysis to assess the role of these contexts in problematic drinking (measured using the Alcohol Use Disorders Identification Test). Results: Six distinct drinking contexts were identified, which differed by gender, three for men and three for women. For both men and women, "social drinking", was associated with problematic drinking. "Home drinking" was also common to men and women but associations with problematic drinking differed, being risky only among men. "Daytime drinking" (women) was associated with risk but "work-related drinking" (men) was not. Both "home drinking" (men) and "daytime drinking" (women) were linked to depression symptoms. Conclusion: Specific contexts appeared to be associated with problematic drinking for both sexes. Among both men and women, "social drinking" was associated with problematic drinking. Both "home drinking" (men) and "daytime drinking" (women) contexts, were associated with problematic drinking and depressive symptoms. Targeted alcohol-focused interventions need to address co-occurring mental health issues.

Predictors of Alcohol Use Disorders Among Young Adults: A Systematic Review of Longitudinal Studies

AIMS

Alcohol use disorders (AUDs) are highly disabling neuropsychiatric conditions. Although evidence suggests a high burden of AUDs in young adults, few studies have investigated their life course predictors. It is crucial to assess factors that may influence these disorders from early life through adolescence to deter AUDs in early adulthood by tailoring prevention and intervention strategies. This review aims to assess temporal links between childhood and adolescent predictors of clinically diagnosed AUDs in young adults.

METHODS

We systematically searched PubMed, Scopus, PsycINFO and Embase databases for longitudinally assessed predictors of AUDs in young adults. Data were extracted and assessed for quality using the Newcastle-Ottawa quality assessment tool for cohort studies. We performed our analysis by grouping predictors under six main domains.

RESULTS AND CONCLUSION

Twenty two studies met the eligibility criteria. The outcome in all studies was measured according to the Diagnostic Statistical Manual of Mental Disorders. Our review suggests strong links between externalizing symptoms in adolescence and AUDs in young adulthood, as well as when externalizing symptoms co-occur with illicit drug use. Findings on the role of internalizing symptoms and early drinking onset were inconclusive. Environmental factors were influential but changed over time. In earlier years, maternal drinking predicted early adult AUD while parental monitoring and school engagement were protective. Both peer and parental influences waned in adulthood. Further high-quality large longitudinal studies that identify distinctive developmental pathways on the aetiology of AUDs and assess the role of early internalizing symptoms and early drinking onset are warranted.

Externalizing and internalizing symptoms in childhood and adolescence and the risk of alcohol use disorders in young adulthood: A meta-analysis of longitudinal studies

BACKGROUND

Evidence suggests that externalizing and internalizing symptoms are expressed early in life and are associated with problematic drinking in young adulthood. However, few studies have examined their role during childhood and adolescence in predicting alcohol problems later in life.

OBJECTIVES

To examine the role of childhood and adolescent externalizing and internalizing symptoms in predicting alcohol use disorders in young adulthood.

METHODS

We searched five electronic databases (PubMed, Scopus, PsycINFO, Web of Sciences and Embase) for studies which diagnosed alcohol use disorders through either the International Classification of Diseases or American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders criteria and followed up children or adolescents into the transition to young adulthood. We performed a meta-analysis and obtained pooled odds ratio estimates with 95% confidence intervals using random-effects models.

RESULTS

A total of 12 longitudinal studies met eligibility criteria and were included in the meta-analysis. All measured the outcome using Diagnostic and Statistical Manual of Mental Disorders criteria. The majority were of good quality and were conducted in the United States. A total of 19,407 participants (50% female) were included in this meta-analysis. Of these, n = 2337 (12%) had diagnoses of alcohol use disorders/alcohol dependence. Participant ages ranged from birth to 36 years. Internalizing symptoms increased the risk of young adult alcohol use disorders by 21% (odds ratio = 1.21; 95% confidence interval = [1.05, 1.39]), with no strong evidence of publication bias. Subgroup analysis suggested significantly lower heterogeneity than for externalizing studies. Externalizing symptoms increased the risk of alcohol use disorders by 62% (odds ratio = 1.62, 95% confidence interval = [1.39, 1.90]). We found some evidence of publication bias and significant heterogeneity in the studies.

CONCLUSION

Our findings highlight the contribution of early behavioural problems to the development of alcohol use disorders in young adulthood and the need for timely scrutiny of and intervention on early behavioural problems.

Willingness to participate in future HIV prevention trials in Beira, Mozambique

In preparation for trials of new HIV prevention methods, willingness to participate (WTP) was assessed in Beira, Mozambique. A total of 1 019 women participating in an HIV incidence study, and 97 men participating in a separate WTP survey, were interviewed. When comparing the answers to questions that were identical in the two studies, WTP was higher among women than men for all prevention methods. Among women, WTP was highest for trials evaluating daily oral pre-exposure prophylaxis (PrEP; 84.4% reporting very likely to participate), followed by vaccination (77.8%), daily vaginal gel use (67.7%), coital vaginal gel use (67.1%) and monthly vaginal ring use (47.7%). Among men, WTP was highest for trials evaluating vaccination (57.6%), followed by daily vaginal gel use for female sexual partners (52.5%), daily oral PrEP (49.5%), coital vaginal gel use for female sexual partners (46.4%) and monthly vaginal ring use for female sexual partners (39.4%). Among men, the most important motivators for trial participation were social benefits, whereas personal risks (most notably receiving injections and/or blood draws) were deterrents; this was not assessed in women. Other important lessons learnt are that male circumcision and antiretroviral drugs were not generally recognised as ways to prevent HIV, that having to use hormonal contraception during trial participation will likely reduce WTP, and that evening clinics are not likely to be popular. The barriers reported in this and other studies may be challenging but are not impossible to overcome.

Prevalence, incidence and determinants of herpes simplex virus type 2 infection among HIV-seronegative women at high-risk of HIV infection: a prospective study in Beira, Mozambique

OBJECTIVES

To estimate the prevalence, incidence and determinants of herpes simplex type 2 (HSV-2) infection, and associations between HSV-2 and incident HIV infection, among women at higher risk for HIV infection in Beira, Mozambique.

METHODS

Between 2009 and 2012, 411 women aged 18-35 years at higher risk of HIV acquisition (defined as having had two or more sexual partners in the month prior to study enrollment) were enrolled and followed monthly for one year. At each study visit, they were counseled, interviewed, and tested for HSV-2 and HIV antibodies.

RESULTS

The HSV-2 prevalence at baseline was 60.6% (95% CI: 55.7% -65.4%). Increasing age (aOR = 2.94, 95% CI: 1.74-4.97, P<0.001 and aOR = 3.39, 95% CI: 1.58-7.29, P = 0.002 for age groups of 21-24 and 25-35 years old respectively), lower educational level (aOR = 1.81, 95% CI: 1.09-3.02, P = 0.022), working full time (aOR = 8.56, 95% CI: 1.01-72.53, P = 0.049) and having practiced oral sex (aOR = 3.02, 95% CI: 1.16-7.89, P = 0.024) were strongly associated with prevalent HSV-2 infection. Thirty one participants seroconverted for HSV-2 (20.5%; 95% CI: 14.4% -27.9%) and 22 for HIV during the study period. The frequency of vaginal sex with a casual partner using a condom in the last 7 days was independently associated with incident HSV-2 infection (aOR = 1.91, 95% CI: 1.05-3.47, P = 0.034). Positive HSV-2 serology at baseline was not significantly associated with risk of subsequent HIV seroconversion.

CONCLUSIONS

Young women engaging in risky sexual behaviors in Beira had high prevalence and incidence of HSV-2 infection. Improved primary HSV-2 control strategies are urgently needed in Beira.

HIV incidence in a cohort of women at higher risk in Beira, Mozambique: prospective study 2009-2012

Background

HIV is prevalent in Sofala Province, Mozambique. To inform future prevention research, we undertook a study in the provincial capital (Beira) to measure HIV incidence in women at higher risk of HIV and assess the feasibility of recruiting and retaining them as research participants.

Methods

Women age 18–35 were recruited from schools and places where women typically meet potential sexual partners. Eligibility criteria included HIV-seronegative status and self-report of at least 2 sexual partners in the last month. History of injection drug use was an exclusion criterion, but pregnancy was not. Participants were scheduled for monthly follow-up for 12 months, when they underwent face-to-face interviews, HIV counseling and testing, and pregnancy testing.

Results

387 women were eligible and contributed follow-up data. Most were from 18–24 years old (median 21). Around one-third of participants (33.8%) reported at least one new sexual partner in the last month. Most women (65.5%) reported not using a modern method of contraception at baseline. Twenty-two women seroconverted for a prospective HIV incidence of 6.5 per 100 woman-years (WY; 95% confidence interval (CI): 4.1–9.9). Factors associated with HIV seroconversion in the multivariable analysis were: number of vaginal sex acts without using condoms with partners besides primary partner in the last 7 days (hazard ratio (HR) 1.7; 95% CI: 1.2–2.5) and using a form of contraception at baseline other than hormonal or condoms (vs. no method; HR 25.3; 95% CI: 2.5–253.5). The overall retention rate was 80.0% for the entire follow-up period.

Conclusions

We found a high HIV incidence in a cohort of young women reporting risky sexual behavior in Beira, Mozambique. HIV prevention programs should be strengthened. Regular HIV testing and condom use should be encouraged, particularly among younger women with multiple sexual partners.

Determinants of prevalent HIV infection and late HIV diagnosis among young women with two or more sexual partners in Beira, Mozambique

Background

The prevalence and determinants of HIV and late diagnosis of HIV in young women in Beira, Mozambique, were estimated in preparation for HIV prevention trials.

Methods

An HIV prevalence survey was conducted between December 2009 and October 2012 among 1,018 women aged 18–35 with two or more sexual partners in the last month. Participants were recruited in places thought by recruitment officers to be frequented by women at higher-risk, such as kiosks, markets, night schools, and bars. Women attended the research center and underwent a face-to-face interview, HIV counseling and testing, pregnancy testing, and blood sample collection.

Results

HIV prevalence was 32.6% (95% confidence interval (CI) 29.7%–35.5%). Factors associated with being HIV infected in the multivariable analysis were older age (p<0.001), lower educational level (p<0.001), self-reported genital symptoms in the last 3 months (adjusted odds ratio (aOR) = 1.4; CI 1.1–2.0), more than one lifetime HIV test (aOR = 0.4; CI 0.3–0.6), and not knowing whether the primary partner has ever been tested for HIV (aOR = 1.7; CI 1.1–2.5). About a third (32.3%) of participants who tested HIV-positive had a CD4 lymphocyte count of <350 cells/µl at diagnosis. Factors associated with late diagnosis in multivariable analyses were: not knowing whether the primary partner has ever been tested for HIV (aOR = 2.2; CI 1.1–4.2) and having had a gynecological pathology in the last year (aOR = 3.7; CI 1.2–12.0).

Conclusions

HIV prevalence and late diagnosis of HIV infection were high in our study population of young women with sexual risk behavior in Beira, Mozambique. HIV prevention programs should be strengthened, health care providers should be sensitized, and regular HIV testing should be encouraged to enroll people living with HIV into care and treatment programs sooner.